Fractures up risk of death in older people: Study
NEW YORK (Reuters Health) - Older men and women who suffer a low-trauma fracture due to the bone-thinning disease osteoporosis are at increased risk of dying for the following 5 to 10 years, compared to the general population, and those who experience another fracture increase their risk of death further for an additional 5 years, Australian investigators report.
Fractures due to osteoporosis represent a growing public health problem, with a projected increasing incidence as the population ages, the investigators note in the Journal of the American Medical Association this week. The current study, they say, suggests that fracture is "a signal event that heralds an increased mortality risk."
Principal investigator Dr. Jacqueline R. Center told Reuters Health: "Patients and physicians need to treat all low-trauma fractures as important events and not just focus on hip fractures. Anti-osteoporosis treatment (assuming a low bone density) should be instituted following any low trauma fracture to at least decrease the risk of a subsequent fracture, although we have yet to see whether it will decrease mortality."
The researchers, from the Garvan Institute of Medical Research in Sydney, examined the long-term risk of death (up to 18 years) following all types of osteoporotic fractures in 2,245 women and 1,760 men aged 60 and older. During follow up, in women, there were 952 low-trauma fractures followed by 461 deaths, and in men, 343 fractures were followed by 197 deaths.
Compared to the general population, an increased risk of death was observed following hip, vertebral (backbone), and major fractures for 5 years post-fracture except for minor fractures, where an increased risk of death was only apparent in those age 75 years or older, the researchers found.
After 5 years, the risk of death decreased, with hip fracture-associated death remaining increased for up to 10 years. After 10 years, death rates were not different from that of an appropriately age-matched population.
"Nonhip, nonvertebral fractures, generally not considered in these types of studies, not only constituted almost 50 percent of the fractures studied, but also were associated with 29 percent of the premature mortality," the investigators note.
About 20 percent to 30 percent of people with one fracture experienced another during the study, which was associated with a 3- to 4-fold increased mortality risk for a further 5 years.
"Given these findings, more attention should be given to nonhip, nonvertebral fractures," the researchers conclude.
As to how fracture increases risk, "the current study showed that several factors were important predictors, including weaker quadriceps strength (men and women), lower bone density, increased sway and having smoked in women and less physical activity for men," Center told Reuters Health. "Presumably these are to some extent surrogates for 'frailty,' but they don't explain the whole picture."
She added, "I think there may be something about the circumstances surrounding the fracture event that has an effect, and we will be actively looking for this in ongoing work."
